USE BLACK OR BLUE INK ONLY TRANSACTION TYPE • FOR …

STATE OF RHODE ISLAND

DIVISION OF MOTOR VEHICLES

600 New London Avenue, Cranston, RI 02920-3024

Phone: 401-462-4368

dmv.

APPLICATION FOR LICENSE,

IDENTIFICATION CARD

AND PERMIT (LI-1)

USE BLACK OR BLUE INK ONLY

? FOR DMV USE ONLY ?

TRANSACTION TYPE

REAL ID CREDENTIAL OPT-IN/OPT OUT BOX (Please select desired credential type)

REAL ID CREDENTIAL

NON REAL ID CREDENTIAL

Note: Non REAL ID Credentials will have ¡°NOT FOR FEDERAL IDENTIFICATION¡± on the card.

IDENTIFICATION CARD (complete sections A, B, C, D, E*, F* G)

LICENSE

NEW

RENEW

DUPLICATE

OUT-OF-STATE

UPDATE _______________

PERMIT (complete sections A, B, C, D, E*, G)

NEW

RENEW

DUPLICATE

SPANISH

PORTUGUESE

**Pre-scheduled appointment required see website

DUPLICATE PERMIT

CASH

CC

AMOUNT: ______________

EYE TEST RESULTS

ATTESTATION FORM USED?

YES

NO

WITH CORRECTIVE LENSES?

YES

NO

RESULTS: ______________ RESTRICTION: ______________

P.O.R. ONE _______________________________________

OTHER (INCLUDING ASL)**

P.O.R. TWO _______________________________________

S.S. CARD _______________________________________

MOTORCYCLE (complete sections A, B, C, D, G)

PERMIT

CHECK

IDENTITY ________________________________________

UPDATE _______________

COMPUTERIZED KNOWLEDGE EXAM (choose one language)

ENGLISH

TIN:

OTHER __________________________________________

LICENSE

A. APPLICANT¡¯S INFORMATION (COMPLETE ALL FIELDS)

LAST NAME:

FIRST NAME:

DATE OF BIRTH: (MM/DD/YY)

GENDER:

M

MIDDLE NAME:

SOCIAL SECURITY NUMBER:

F

SUFFIX:

RI DRIVER¡¯S LICENSE # / R.I. ID # / PERMIT #:

X

EMAIL ADDRESS:

PASSPORT / EMPLOYMENT AUTHORIZATION / RESIDENT ALIEN CARD #:

STREET ADDRESS: RESIDENCE ADDRESS

APT/UNIT # or FLOOR #: CITY/TOWN:

STATE:

ZIP CODE:

STREET ADDRESS: MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE)

APT/UNIT # or FLOOR #: CITY/TOWN:

STATE:

ZIP CODE:

TELEPHONE: CIRCLE PHONE TYPE:

(

Landline Cell

)

ACTIVE MILITARY:

YES

100% DISABLED VETERAN:

NO

YES

NO

VETERAN DESIGNATION:

(DD 214 MUST BE SHOWN,

YES STATING ¡°HONORABLE DISCHARGE¡±)

NO

B. PLACE OF BIRTH (COMPLETE ALL FIELDS)

COUNTRY:

STATE/PROVINCE:

CI T Y :

C. PHYSICAL INFORMATION (COMPLETE ALL FIELDS)

HEIGHT: FT./IN.

WEIGHT: LBS.

EYE COLOR: (check one)

BROWN

GREEN

GRAY

DICHROMATIC

BLUE

BLACK

HAZEL

PINK

HAIR COLOR: (check one)

BLACK

BROWN

BLONDE

RED

WHITE

BALD

GRAY

D. GENERAL QUESTIONS (COMPLETE ALL FIELDS)

1. Are you a U.S. citizen?

2. Do you want to register (or continue to be registered) as an Organ and Tissue Donor?

(If you are currently registered as an organ and tissue donor, you will remain registered only if you choose YES every time.)

Visit for more information.

YES

NO

YES

NO

3. We will use your information to update your voter registration or register you to vote.

Party: __________________________________

Do not use my information for voter registration. (Your decision not to register to vote is confidential. If you register, the place where you register is

confidential.) If you are under age 16, you will not be registered to vote. If you are at least age 16, you will be pre-registered to vote. (You must be at least age 18 to vote.)

4. Do you wear corrective lenses/glasses for driving?

YES

NO

5. I acknowledge that receiving a Rhode Island Permit, License or ID card may cancel or invalidate any Permit, License or ID Card

from another state per the laws of that state. Customer must initial the line to the right of this statement to acknowledge that

_____________

they have read this statement. Please sign initials on the line to the right of this text.

INITIAL HERE

IF YOU ARE TRANSFERRING A LICENSE FROM ANOTHER STATE, PLEASE COMPLETE THE FOLLOWING INFORMATION BELOW:

STATE: __________ LIC. #: _______________ EXP.: _______________ ENDORSEMENTS: _______________ RESTRICTIONS: _______________

NOTICE TO MALES 18 TO 26 YEARS OF AGE:

Pursuant to RI Gen. Laws 31-10-47(a), ¡°(a)ny male, United States citizen or immigrant who is at least eighteen (18) years of age, but less than twentysix (26) years of age shall be registered in compliance with the requirements of section 3 of the "Military Selective Service Act", 50 U.S.C. App. 451 et

seq., when applying to receive a driver's license, renewal or identification card or renewal.¡± Pursuant to RI Gen. Laws 31-10-47(b), the applicant

recognizes that by submitting this application he is consenting to registration with the Selective Service system, if so required by federal law.

CONTINUED ON BACK

LI-1

rev. 4/21

NOTE: IF LICENSE, ID OR PERMIT IS LOST, PLEASE COMPLETE ¡°SECTION E¡± BELOW.

E*. AFFIDAVIT OF LOST LICENSE, LOST ID OR LOST PERMIT (COMPLETE ONLY IF LOST PERMIT, LICENSE OR ID)

I, THE UNDERSIGNED, DECLARE UNDER PENALTY OF PERJURY THAT THE RHODE ISLAND LICENSE, IDENTIFICATION CARD OR PERMIT

ISSUED TO ME WAS LOST, DESTROYED OR STOLEN. IF THE RHODE ISLAND LICENSE, IDENTIFICATION CARD OR PERMIT AGAIN COMES

INTO MY POSSESSION, I WILL IMMEDIATELY RETURN THE SAME TO THE DIVISION OF MOTOR VEHICLES.

APPLICANT¡¯S SIGNATURE:

DATE: (MM/DD/YY)

F*. VOLUNTARY TERMINATION OF A LICENSE AFFIDAVIT (COMPLETE ONLY IF SURRENDERING YOUR RI LICENSE)

PLEASE ACCEPT THIS ATTACHED LICENSE FOR TERMINATION UNDER THE AUTHORITY OF THE STATE STATUTES REGARDING VOLUNTARY

TERMINATION.

MY REASON FOR REQUESTING TERMINATION ON A VOLUNTARY BASIS IS:

I AM MAKING THIS REQUEST ON BEHALF OF MYSELF AND HEREBY ACKNOWLEDGE THE FOLLOWING:

(a) A RECORD OF THIS TRANSACTION WILL BE ENTERED INTO A LICENSE FILE AS A VOLUNTARY SURRENDER.

(b) I WILL BE PRECLUDED UNDER LAW FROM MAKING APPLICATION FOR ANOTHER LICENSE/PERMIT TO OPERATE FOR A PERIOD OF:

OPERATOR¡¯S LICENSE = 6 MONTHS

CHAUFFEUR¡¯S LICENSE = 1 YEAR

(c) PRIOR TO ANOTHER LICENSE BEING ISSUED, WRITTEN AND ROAD EXAMINATIONS WILL BE REQUIRED.

(d) AFTER THIS VOLUNTARY TERMINATION, I WILL BE REQUIRED TO PAY ALL REQUIRED LICENSING FEES IF APPLICATION IS MADE FOR

ANOTHER LICENSE.

NOTE: TERMINATION WILL NOT BE PROCESSED WITHOUT LICENSE OR AFFIDAVIT COMPLETED.

LICENSE #:

EXPIRATION DATE:

LICENSE PHYSICALLY SURRENDERED?

YES

NO

DATE: (MM/DD/YY)

APPLICANT¡¯S SIGNATURE:

G. SIGNATURE

EXCEPT AS AUTHORIZED BY LAW, THE DMV WILL NOT DISCLOSE PERSONAL INFORMATION WITHOUT YOUR CONSENT.

YES

DO YOU CONSENT TO SUCH DISCLOSURE?

NO

I, THE UNDERSIGNED, HEREBY MAKE APPLICATION FOR EITHER A LICENSE, STATE IDENTIFICATION CARD OR PERMIT AND DECLARE UNDER PENALTY OF

PERJURY THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

THE UNDERSIGNED (HEREINAFTER REFERRED TO AS ¡°APPLICANT¡±) SWEARS THAT, IN COMPLIANCE WITH TITLE 31, CHAPTER 47 OF THE GENERAL LAWS, MOTOR

AND OTHER VEHICLES, KNOWN AS THE MOTOR VEHICLE REPARATIONS ACT, HE/SHE WILL NOT OPERATE OR BE ALLOWED TO OPERATE THE MOTOR VEHICLE

DESCRIBED IN THE REGISTRATION NOR OTHER MOTOR VEHICLE UNLESS ALL SUCH MOTOR VEHICLES ARE COVERED FOR FINANCIAL SECURITY. PENALTIES FOR

FAILURE TO COMPLY WITH PROVISIONS OF THE ACT MAY RESULT IN FINES AND/OR SUSPENSION OF LICENSE AND REGISTRATION.

APPLICANT¡¯S SIGNATURE:

DATE: (MM/DD/YY)

MINOR LAW CHAPTER 31-10 OF THE GENERAL LAWS OF RHODE ISLAND, 1956 AS AMENDED. CERTIFICATION BY PARENT(S) OR SUCH RESPONSIBLE PERSON AS

INDICATED IN CHAPTER ¡ì 31-10 FOR A MINOR UNDER 18 YEARS OF AGE.

IF A MINOR IS APPLYING FOR A PERMIT, COMPUTERIZED KNOWLEDGE EXAM, OR FIRST LICENSE, THE APPLICATION MUST BE SIGNED BY A PARENT, LEGAL

GUARDIAN, LICENSED FOSTER PARENT, OR RESPONSIBLE ADULT. IF THERE IS NO QUALIFIED PARENT, LEGAL GUARDIAN, OR LICENSED FOSTER PARENT,

ANOTHER RESPONSIBLE ADULT WILLING TO ASSUME THE OBLIGATION IMPOSED UNDER ¡ì31-10-1 ¨C 31-10-33 MAY SIGN. IN THE EVENT THE PARENT, LEGAL

GUARDIAN, LICENSED FOSTER PARENT, OR RESPONSIBLE ADULT IS NOT PRESENT AT THE TIME THE APPLICATION IS SUBMITTED TO THE DMV, THEN THE

SIGNATURE ON THE FORM WILL ONLY BE ACCEPTED IF NOTARIZED. COURT PAPERS OR APPROPRIATE DOCUMENTATION MUST BE PRESENTED TO THE DMV

WHEN A LEGAL GUARDIAN OR LICENSED FOSTER PARENT IS SIGNING FOR A MINOR.

DMV CUSTOMER SERVICE EMAIL ADDRESS: DMV.CustomerService@dmv.

IF RI NOTARY, STAMP MUST BE INK AND NOT EMBOSSED

MOTHER¡¯S/FATHER¡¯S/GUARDIAN¡¯S SIGNATURE:

NOTARY PUBLIC SIGNATURE:

NOTARY PRINTED NAME:

COMMISSION EXPIRATION DATE (MANDATORY):

DATE: (MM/DD/YY)

COMMISSION STATE (MANDATORY):

FOR ENFORCEMENT OFFICE ONLY

STAMP

IDENTITY _______________________________

P.O.R. ONE _____________________________

P.O.R. TWO _____________________________

VALID UNTIL _________________

DATE

DMV OFFICIAL ________________

S.S. CARD ______________________________

OTHER ________________________________

LI-1

rev. 4/21

REAL ID LICENSE & ID CARDS

Rhode Island DMV ¨C Document Checklist

dmv.

Rev. 2/21

NOTE: ALL REAL ID LICENSE AND ID TRANSACTIONS REQUIRE A COMPLETED LI-1 FORM AND

THE CORRECT NUMBER OF REQUIRED DOCUMENTS LISTED IN THE 2 BOXES BELOW

Proof of Identity Documents List

You must present one (1). These must bear the

applicant¡¯s legal name and date of birth.

A valid, unexpired U.S. passport;

A certified copy of a birth certificate filed with a

State Office of Vital Statistics or equivalent agency in the

individual's State of birth;

A Consular Reportof Birth Abroad (CRBA) issued by

the U.S. Department of State, Form FS-240, DS-1350 or

FS-545;

A valid, unexpired Permanent Resident Card

(Form I-551) issued by DHS or INS;

An unexpired Employment Authorization Document

(EAD) issued by DHS, Form I-766 or Form I-688B;

An unexpired foreign passport with a valid,

unexpired U.S. visa affixed accompanied by the

approved I-94 form documenting the applicant's most

recent admittance into the U.S.;

A Certificate of Naturalization issued by DHS, Form

N-550 or Form N-570; or

A Certificate of Citizenship, Form N-560 or Form

N-561, issued by DHS.

Proof of a change to the name contained on the

applicant¡¯s primary identity document must be

demonstrated with a document issued by an authorized

government agency.

If you have obtained or renewed your passport within

the last 6 months, please bring an additional Identity

Document, as your passport may not verify with the

national database.

Proof of Residency Documents List

You must present two (2). P.O. Box addresses will not be accepted.

A utility bill (gas, electric, telephone, cable, oil, water, sewer, satellite, heat, cell phone) with the address of residence clearly stated in the

applicant¡¯s name or in the name of a member of the applicant¡¯s immediate family dated within the past sixty (60) days;

A personal check orbank statement with the applicant¡¯s name and address of residence dated within the past sixty (60) days;

A payroll check with the applicant¡¯s name and address of residence dated within the past sixty(60) days;

A lease agreement currently in effect. The lease agreement must contain the applicant's name and address of residence and the landlord¡¯s

name, address, and telephone number.

Handwritten lease agreements will not be accepted;

$letter issued by a Rhode Island state agency or a federal agencyZLWKWKHDSSOLFDQW VQDPHDQGDGGUHVVRIUHVLGHQFHDSSURYLQJQDPH

DQGaddress of residence approving the applicant¡¯s receipt of benefits from an entitlement program dated within the past sixty (60) days;

A homeowner¡¯s or renter¡¯s insurance policy for the applicant¡¯s home or apartment with the applicant¡¯s name and address of residence that

is currently in effect;

An automobile insurance policy for the applicant¡¯s motor vehicle with the applicant¡¯s name and address of residence that is currently in

effect;

A property tax bill for the applicant¡¯s residence from the immediately preceding year;

A letter from a Rhode Island shelter or halfway house indicating that the applicant resides at the facility. Such a letter must be on

letterhead, must be dated within the past thirty(30) days and must include the name and contact information of an administrator of the shelter or

halfway house; or

A jury duty summons dated within the past sixty (60) days;

A W-2 form with the applicant¡¯s name and address of residence from the immediately preceding year;

An installmentloan contract (automobile, student loan) with the applicant¡¯s name and address of residence that is currently in effect;

A current Social Security Administration statement with the applicant¡¯s name and address of residence;

A current pension or retirement account statement with the applicant¡¯s name and address of residence;

A Rhode Island-issued firearms permit with the applicant¡¯s name and addres if residence that is currently in effect; or

A valid RhodeIsland driver¡¯s license or identification card;

If the applicant is a minor, in addition to any of the proof of residency documents listed above, the following are accepted:

A school record from the current school year (report card, diploma, transcript, or ID card)stating the student¡¯s address of

residence (past year if during summer vacation)

The Rhode Island driver¡¯s license or identification card of the individual signing the minor's application.

Note: All U.S. Territories driver¡¯s license transfers and RI State ID cards are only done at the DMV Cranston Headquarters.

These transactions are not performed at any DMV or AAA branch office.

PROOF OF SOCIAL SECURITY NUMBER: PROVIDE YOUR SOCIAL SECURITY NUMBER ON THE LI-1 OR CDL-1 FORM OR A LETTER ISSUED BY THE SOCIAL SECURITY ADMINISTRATION

STATING THAT THE APPLICANT IS NOT ELIGIBLE TO RECEIVE A SOCIAL SECURITY NUMBER

NOTE: EACH OF THE TRANSACTION DESCRIPTIONS BELOW REQUIRE ADDITIONAL DOCUMENTS ALONG WITH THE SUPPORTING DOCUMENTS FROM ABOVE

New Permit

Out-of-State Transfer

Name Change

RI License/ID/Permit

Your current license from the other state

Driver Education Certificate (if under 18) ?

Please note you must wait 24 hours for Renewal or Duplicate

If the out-of-state license is not available at time of

- If you have a driving certificate, that has not

name change to register with the Social Security AND New ID

been approved by CCRI, you must take the

knowledge exam test.

? If under 18 years of age and applying for a

learner¡¯s permit, the LI-1 form must be notarized if

parent/guardian has a different last name than

applicant.

American Sign Language (ASL) computerized

permit exams or selected foreign language permit

exams (please refer to DMV website for details)

require a pre-scheduled appointment.

Administration

Current RI license or Identification card

Original government issued document

indicating name change (ex. Marriage

Certificate or Divorce Decree)

Address Change

Current RI license or Identification

card

DMV Customer only needs completed LI-1

or CDL-1 form and the required supporting

documents from above.

All non U.S. citizens must bring all

supporting documents to be reviewed.

Gender Change

Gender Designation form

Current RI license or Identification

card

transfer you must submit a driving record or

verification from the other state with an Identity

Document (see list).

Motorcycle Permit

Certificate of completion from the RI Motorcycle

Safety course

Current RI license (must hold permit for 30 days)

Motorcycle License

Current license and valid motorcycle permit

Rhode Island DMV ¨CDocument Checklist

New Permit

LI-1 form

A certified birth certificate (not a copy) or Proof of

Identity Document (see list)

Driver Education Certificate (if under 18) ?

- If you have a driving certificate, that has not

been approved by CCRI, you must take the

knowledge exam test.

Proof of a Social Security Number

Two (2) Proof of residency (see list)

? If under 18 years of age and applying for a

learner¡¯s permit, the LI-1 form must be notarized if

parent/guardian has a different last name than

applicant.

American Sign Language (ASL) computerized

permit exams or selected foreign language permit

exams (please refer to DMV website for details)

require a pre-scheduled appointment.

NON REAL ID LICENSE & ID CARDS

Name Change

LI-1 or CDL-1 form

Current RI license or Identification card

Original government issued document

indicating name change (ex. Marriage

Certificate or Divorce Decree)

Please note you must wait 24 hours for

name change to register with the Social Security

Administration)

New ID

LI-1 form

A certified birth certificate (not a copy) or

Proof of Identity Document (see list)

Two (2) Proof of residency (see list)

Proof of a Social Security Number

Proof of Identity Documents List

You must present one (1). These must bear the

applicant¡¯s legal name and date of birth.

A valid, unexpired U.S. passport ;

A certified copy of a birthcertificate filed with a State

Office of Vital Statistics or equivalent agency in the

individual's State of birth;

A Consular Report of BirthAbroad (CRBA) issued by

the U.S. Department of State, Form FS-240, DS- 1350 or

FS-545;

A valid, unexpired PermanentResident Card (Form I-551)

issued by DHS or INS;

An unexpired Employment Authorization Document (EAD)

issued byDHS, Form I-766 or Form I-688B;

An unexpiredforeign passport with a valid, unexpired

U.S. visa affixed accompanied by the approved I-94 form

documentingthe applicant's most recent admittance into the

U.S.;

A Certificate of Naturalization issued by DHS, Form N-550

or Form N-570;

A Certificate of Citizenship, Form N-560 or Form N- 561,

issued by DHS;

A U.S. Active Service, Retiree, or Reservist Military ID

Card;

A Native American Tribal ID Card;

A valid U.S. Driver¡¯s License with photograph,

signature, and date of birth (must not be expired for more

than one year);

A valid U.S. Territory Driver¡¯s License with photograph,

signature, and date of birth (must not be expired for more than

one year);

A valid Canadian Driver's License with photograph,

signature, and date of birth (must not be expired for more than

one year); or

An employment authorization document (EAD) issued by

DHS, Form I-766, that indicates a grant of deferred action under

the Deferred Action for Childhood Arrivals (DACA) Program.

Note: Non REAL ID Credentials will have ¡°NOT

FOR FEDERAL IDENTIFICATION¡± on the card.

RI License/ID/Permit

Renewal or Duplicate

dmv.

Rev. 2/21

Out-of-State Transfer

LI-1 or CDL-1 form

Your current license from the other state

Two (2) Proof of residency (see list)

LI-1 or CDL-1 form

One identity document (see list)

All non U.S. citizens must bring all

If the out-of-state license is not available at time of

supporting documents to be reviewed. transfer you must submit a driving record or

verification from the other state with an Identity

Address Change

Document (see list).

LI-1 or CDL-1 form

Motorcycle Permit

Current RI license or Identification

card

LI-1 or CDL-1 form

Certificate of completion from the RI Motorcycle

Gender Change

Safety course

Current RI license (must hold permit for 30 days)

LI-1 or CDL-1 form

Gender Designation form

Motorcycle License

Current RI license or Identification

LI-1 or CDL-1 form

card

Current license and valid motorcycle permit

Proof of Residency Documents List

You must present two (2). P.O. Box addresses will not be accepted.

A utility bill (gas, electric, telephone, cable, oil, water, sewer, satellite, heat, cell phone) with the address of residence clearly stated in the

applicant¡¯s name or in the name of a member of the applicant¡¯s immediate family dated within the past sixty (60) days;

A personal check orbank statement with the applicant¡¯s name and address of residence dated within the past sixty (60) days;

A payroll check with the applicant¡¯s name and address of residence dated within the past sixty(60) days;

A lease agreement currently in effect. The lease agreement must contain the applicant's name and address of residence and the landlord¡¯s

name, address, and telephone number.

Handwritten lease agreements will not be accepted;

A letter issued by a Rhode Island state agency or a federal agency with the applicant's name and address of residence approving name

and address of residence and the landlord¡¯s name, address, and telephone number;

A homeowner¡¯s or renter¡¯s insurance policy for the applicant¡¯s home or apartment with the applicant¡¯s name and address of residence that

is currently in effect;

An automobile insurance policy for the applicant¡¯s motor vehicle with the applicant¡¯s name and address of residence that is currently in

effect;

A property tax bill for the applicant¡¯s residence from the immediately preceding year;

A letter from a Rhode Island shelter or halfway house indicating that the applicant resides at the facility. Such a letter must be on

letterhead, must be dated within the past thirty(30) days and must include the name and contact information of an administrator of the shelter or

halfway house; or

A jury duty summons dated within the past sixty (60) days;

A W-2 form with the applicant¡¯s name and address of residence from the immediately preceding year;

An installmentloan contract (automobile, student loan) with the applicant¡¯s name and address of residence that is currently in effect;

A current Social Security Administration statement with the applicant¡¯s name and address of residence;

A current pension or retirement account statement with the applicant¡¯s name and address of residence;

A Rhode Island-issued firearms permit with the applicant¡¯s name and addres if residence that is currently in effect; or

A valid RhodeIsland driver¡¯s license or identification card;

If the applicant is a minor, in addition to any of the proof of residency documents listed above, the following are accepted:

A school record from the current school year (report card, diploma, transcript, or ID card)stating the student¡¯s address of

residence (past year if during summer vacation)

The Rhode Island driver¡¯s license or identification card of the individual signing the minor's application.

Note: All U.S. Territories driver¡¯s license transfers and RI State ID cards are only done at the DMV Cranston Headquarters.

These transactions are not performed at any DMV or AAA branch office.

 ................
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